Infectious Disease Epidemiology Section Office of Public Health, Louisiana Dept. of Health & Hospitals 800-256-2748 (24 hr. number) www.infectiousdisease.dhh.louisiana.gov Ebola Hemorrhagic Fever Ebola Virus Disease (EVD) 12/01/2014 “The bottom line with Ebola is we know how to stop it: traditional public health. Find patients, isolate and care for them; find their contacts; educate people; and strictly follow infection control in hospitals. Do those things with meticulous care and Ebola goes away.” Tom Frieden, MD, MPH - Director of the Centers for Disease Control and Prevention This manual is based on the CDC recommendations. It is presented in a very concise format to provide infection preventionists and epidemiologists a single document grouping all information necessary to understand Ebola transmission, patient management and epidemic prevention. This manual is updated weekly. For the most recent information access the CDC website. The word Ebola is sometimes used as a synonym for Ebola Virus Disease. Table of Contents Ebola Hemorrhagic Fever....................................................................................................................... 1 1-Epidemiology ...................................................................................................................................... 6 1.1-The virus ...................................................................................................................................... 6 1.2-Incubation period is important ..................................................................................................... 6 1.3-Transmission, source of the virus ................................................................................................. 7 ABC to fight Ebola: Avoid Body Contact .................................................................................. 7 1.4-Viral load ...................................................................................................................................... 7 1.5-Environmental source................................................................................................................... 8 1.6-Outbreaks ..................................................................................................................................... 9 1.7-No outbreak outside of the endemic area (Africa) ..................................................................... 10 1.8-Fear and perceptions .................................................................................................................. 10 2-Clinical Presentation and Clinical Course ......................................................................................... 10 2.1-Pathogenesis ............................................................................................................................... 10 2.2-Symptoms ................................................................................................................................... 11 3-Diagnosis ........................................................................................................................................... 12 Louisiana Office of Public Health – Infectious Disease Epidemiology Section Page 1 of 48 3.1-Tests ........................................................................................................................................... 12 3.2-Infection Control for Collecting and Handling Specimens ........................................................ 12 3.3-Specimen Handling for Routine Laboratory Testing (not for Ebola Diagnosis) ........................ 13 3.4-When Specimens Should Be Collected for Ebola Testing ......................................................... 13 3.5-Preferred Specimens for Ebola Testing ...................................................................................... 13 3.6-Storing Clinical Specimens for Ebola ........................................................................................ 13 3.7-Diagnostic Testing for Ebola Performed at the CDC ................................................................. 13 3.8-Transporting Specimens within the Hospital / Institution .......................................................... 13 4-Treatment .......................................................................................................................................... 14 5-Preventing EBV from Spreading Beyond the Epidemic Area .......................................................... 15 5.1-Screening at departures .............................................................................................................. 15 5-2-Screening at arrival in the U.S. .................................................................................................. 15 5.2.1-Procedure to Conduct Acting Traveler Health Monitoring and Follow-up: ....................... 15 5.2.2-Travel restriction ................................................................................................................. 16 5.3-Travel recommendations for U.S. travelers to the outbreak areas ............................................. 16 Those of you that must travel to an area affected by the Ebola outbreak ..................................... 16 After return, pay attention to your/their health ............................................................................. 17 5.4-Guidance on Air Medical Transport for Patients with Ebola Virus Disease .............................. 17 6- Students /Faculty Arriving to U.S. Campuses from EBV Outbreak Countries ............................... 17 6.1-Student health centers ................................................................................................................ 17 6.2-Isolate or quarantine students and faculty coming from countries where the Ebola outbreaks are occurring? ............................................................................................................................................... 17 6.3-Keeping people on campus safe from Ebola? ............................................................................ 18 6.4-Health information for arriving persons from EVD outbreak countries .................................... 18 7-Public health approach to prevent the spread of Ebola in the U.S. ................................................... 19 7.1--Case Definitions ........................................................................................................................ 19 7.1.1--Person of Interest (POI - OPH terminology) ..................................................................... 19 7.1.2-Person Under Investigation (PUI - CDC terminology) ....................................................... 19 7.1.3-Confirmed Case (CDC terminology) .................................................................................. 19 7.1.4-Close contact ....................................................................................................................... 19 7.1.5-Areas of EVD active transmission ...................................................................................... 19 7.2-Person Exposure Evaluation ...................................................................................................... 19 NOTE: This classification is presented here for information only. The Louisiana Administration does not use this classification to establish a risk-based approach. ........................................................ 20 High risk: direct contact of infected body fluids .............................................................................. 20 Some risk: In countries with widespread transmission or urban areas with uncertain control ......... 20 Low risk (but not zero) ..................................................................................................................... 20 In country with widespread Ebola transmission previous 21 days and having no known exposure 20 Louisiana Office of Public Health – Infectious Disease Epidemiology Section Page 2 of 48 In countries without widespread Ebola transmission ....................................................................... 20 7.3-Decision to test or monitor according to CDC Guidelines. ........................................................ 21 NOTE: This decision tree is presented here for information only. The Louisiana Administration does not use this decision tree to set the control measures. .................................................................... 21 7.3.1-EVD Medical evaluation for all high, some, and low risk categories ................................. 21 7.3.2-Medical evaluation for other diseases for no risk category ................................................. 21 7.4- Follow up actions ...................................................................................................................... 21 7.4.1- The Louisiana Sanitary Code Title 51, Public health, Part II: The control of Diseases / Isolation /Quarantine ........................................................................................................................... 21 7.4.2-Active monitoring: reporting to PH .................................................................................... 22 7.4.3-Direct active monitoring: Observing by PH ........................................................................ 22 7.4.4. Travel restrictions /Controlled movements .......................................................................